INTRODUCTION

Few delegates at this conference need to be convinced of the benefits of
cycling, either as environmentally friendly, pollution free transport,
or as healthy exercise. Indeed, the British Medical Association reported:
(despite the risk of accidents) "car travel is more deleterious to health
unless the motorist can exercise several times a week by other means that
will maintain fitness" (Cycling Towards Health and Safety, Oxford Univ
Press, 1992). Nowadays, only a minority of the population takes
sufficient exercise and several billions are spent every year on hospital
treatment of heart and circulatory disease, much of which might be prevented
by regular exercise such as cycling. Cycle helmets may be beneficial
if they help reduce the risk of head injury, but many cyclists find them
hot or uncomfortable. Helmet laws might therefore be counter-productive
if they discourage cycling sufficiently for the loss of health and social
benefits from reduced cycling to outweigh gains from fewer head injuries.
Here, an attempt is made to shed light on this difficult question by reviewing
available statistics on head injuries and cycling participation before
and after helmet laws were passed in Australia.

HELMET
LAWS AND CYCLING ACTIVITY

Only two states - Victoria and NSW - attempted to measure the effect of
the laws on cycling activity by pre- and post-law surveys at the same sites,
observation periods, time of year and, where possible, the same observers.
In NSW, data from identical pre- and post-law surveys were available only
for children. Both surveys were conducted in excellent weather.
Table 1 shows that the increase in numbers wearing helmets was only about
half the decrease in cyclists counted, with similar outcomes for cycling
in recreational areas, through road intersections, or to school.
Reductions in rural NSW (35%) and in the Sydney Metropolitan area (37%)
were almost identical. Another survey was carried out a year later,
under fine and generally sunny conditions. Even fewer cyclists
were counted.

Table 1. Counts of child cyclists in
NSW before and in the first two years of the helmet law (RTA surveys*14 , 33)

Year

1991 (Pre-law)

1992 (1st law yr)

1993 (2nd law yr)

Location

Total

counted

No

helmeted

Total

counted

No

helmeted

Total

counted

No

helmeted

Road Intersections

1741

440

1188

874

881

582

Change from 1991

-553

434

-860

142

Recreational areas

1742

709

1236

899

1184

872

Change from 1991

-506

190

-558

163

School gates

2589

761

1433

1156

1349

1025

Change from 1991

-1156

395

-1240

264

Total child cyclists

6072

1910

3857

2929

3414

2479

Change from 1991

-2215

1019

-2658

569

Figure 1. Counts of cyclists with and without
helmets in Victoria,
pre- (May 1990) and post- (May 1991) helmet law (source: MUARC surveys 7).
In Victoria, both adults and child cyclists were counted. The
same sites and observation times were used and 82% of sites had the same
weather classification. Overall, 36% fewer cyclists were
counted (Figure 1). For sites which
were fine in both 1990 and 1991, the reduction was, however, only 24%.
The survey was repeated the following year, when a bicycle rally happened
to pass through one of the sites. Excluding this site, numbers in
the second year were down by 27% on the pre-law survey. These figures
indicate, as in NSW, that the increase in numbers wearing helmets was less
than the overall decrease in numbers of cyclists.

Attitude surveys confirm the potential of helmet laws to discourage cycling.
A total of 1210 secondary school students were questioned as part of the
Blacktown Bike Plan. Of those who had not ridden in the past week,
helmet restriction was the most common reason (33.9%) compared with unsafe
(11.8%) or even not owning a bike (33.8%). A street survey in the
Northern Territory of more than 800 people found 20% had given up cycling
because of the law and a total of 42% had reduced their cycling.
In the ACT, when 325 cyclists were asked "Would you cycle less if helmets
became compulsory?" 90 (28%) said they would. In Western Australia
(WA), a telephone survey of 254 households in which adults responded on
behalf of themselves and their children found 13% of Perth and 8% of country
cyclists had given up or cycled less because of the law. 31
However, when the adult respondents replied for themselves, a proportion
equivalent to 64% of current adult cyclists said they would cycle more
if not legally required to wear a helmet. Thus, apart from the WA telephone
survey (suffering from a small sample size and that parents may not always
be aware of a child's true motives), street counts and survey interviews
have both consistently revealed a substantial deterrent of helmet laws
on cycling.

HEAD INJURIES

Figure 2. Cyclist hospital admissions for
head and other injuries by month, Victoria. (MUARC Rpt 76)Figure 2 shows hospital admissions of cyclists for head
and other injuries in Victoria in the years before and after the helmet
law. Non-head injury admissions (right hand axis of graph)
outnumbered those for head injury by a factor of approximately 2:1,
both before and after the law.
Consistent with surveys indicating reduced cycling, the effect of the law
can be clearly seen by a reduction in both head and non-head injury admissions,
but, despite a substantial increase in helmet wearing from 31% of cyclists
to 75%, the relative proportions of the two appear little changed.

Figure 3. NSW. Helmet wearing
(w%)14 , 33
and cyclist hospital admissions by year to end June.NB law
for children introduced 6 months after adult law.
Figure 3 shows
pre- and post-law helmet wearing rates in NSW14,33 together with hospital
data. A generally declining trend is apparent in the percentage of
adult cyclists admitted to hospital suffering head injuries, but no clear
effect of the helmet law, estimated to have increased helmet wearing rates
from 26% to 77% and 85% of adults in the 1st and 2nd years of the law.
For child cyclists, a small reduction can be seen in the percentages with
head injury over and above a generally declining trend. However,
head injuries to child cyclists declined by only 29% in years 1 and 2,
compared with reductions of 36% and 44% in numbers of child cyclists observed.
If the surveys were representative of the effect of the law on cycling
participation, then the risk of head injury would appear to have increased,
rather than decreased, because of an increase in accident rates.
Researchers have developed the theory of risk compensation to explain why
accidents often appear to increase following adoption of a new safety
measure. In many cases, the benefits of the measures are large and
outweigh any effects of risk compensation. Comparison of head injury
and cycling participation rates following helmet laws in NSW and other
places leads to the possibility this is not the case for bike helmets.

Fig 4. South Australia. Cyclist
hospital admissions and helmet wearing (%W)20
by year to June.Hospital data for South Australia (SA) 20 is
given in Figure 4. Percentage of cyclist admissions are graphed separately
for those suffering concussion and other head/face injuries. The
steady decline in admissions for concussion may, in part, relate to changes
in admissions policy in that some hospitals no longer routinely admit patients
who suffered a short episode of concussion. 29
No additional effect of the law is apparent on concussions. For other
head injuries, the effect is difficult to determine. Rates were no
different in 1992-3 with mandatory helmets than in 1988-89 when wearing
was limited. We may therefore conclude increasing helmet
wearing from 40 to 90% of all cyclists had a relatively small effect, compared
with other factors affecting the risk of head injury. A similar conclusion
was obtained from head injury data in New Zealand. As in the Australian
data, trends were apparent in rates of head injury and noted to be "present
before, and independent of, helmet wearing." 18
After accounting for this trend, increased helmet wearing had "little association
with serious head injuries as a percentage of all serious injuries to cyclists."
18

OTHER ROAD SAFETY MEASURES

Figure 5. Road fatalities in NSW by yearThe relatively
small effects of the helmet laws (except on numbers of cyclists) contrasts
starkly with other measures such as random breath testing (RBT), introduced
in NSW in December 1982. Other recent measures have included the highly
successful Transport Accident Commission (TAC) road safety campaign in
Victoria which reduced accident costs by $220 million for an outlay of
$5.5 million. 10 Included was a crack-down
on speeding and drink-driving via speed cameras and increased RBT
('booze busses'). Pedestrian fatalities in Victoria fell from 159
in 1989 to 93 the following year. 9 These initiatives
started around the same time as the helmet law. Comparing the two
years before the helmet law with the following two, the percentage of TAC
pedestrian injury claims involving death or head injury fell by 4.2 from
19.6% to 15.4% Despite increased helmet wearing from 31%-75%, the
decrease for cyclists injured in collisions with vehicles was 3.1, from
12.0% to 8.9%. While some of this may have been due to helmets, the
large effect seen for pedestrians, together with comparatively small effects
for cyclists in accidents not involving motor vehicles, makes it plausible
that a substantial proportion of this effect, previously attributed entirely
to increased helmet wearing, may, in fact, have been due to the effective
TAC campaign.

CONCLUSIONS

The fact that little or no obvious effect can be seen in hospital data
does not imply cyclists choosing to wear lightweight, comfortable, well
fitting helmets, will not benefit, provided they do not ride on more
dangerous roads or take less care. The relatively small effects from
helmet laws must, however, be contrasted with the large effect on numbers
of cyclists and better responses from other road safety campaigns.